Managing Diabetes with 'The Power of Five'

According to ICMR–INDIAB population-based cross-sectional study states with higher per-capita GDP seemed to have a higher prevalence of diabetes (e.g. Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13•6%, 12.8–15•2). In rural areas of all states, diabetes was more prevalent in individuals with higher socio economic status (SES).ETHealthWorld | January 30, 2018, 15:41 IST

Diabetes, also known as ‘The Silent Killer’ is a lifestyle disease that has invaded the modern day lifestyle. Worryingly, the epidemic shows no signs of relenting, with the number of people living with diabetes expected to reach 135 million by 2045. Around 7.3% of Indians with diabetes have type 2 diabetes, with 10-12% of adults having diabetes in the urban population.

According to ICMR–INDIAB population-based cross-sectional study states with higher per-capita GDP seemed to have a higher prevalence of diabetes (e.g. Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13•6%, 12.8–15•2). In rural areas of all states, diabetes was more prevalent in individuals with higher socio economic status (SES).

What is important to note here is that not only people in metros are diabetic but also, people with higher SES in rural areas are becoming diabetic with time. What could be the reasons for this shift? Environmental and lifestyle changes resulting from industrialization and migration to urban environment from rural settings, could be responsible to a large extent, for this epidemic of Type 2 diabetes in Indians. In fact, the lifestyle improvisations even at the rural level have at large contributed to increase in diabetes. Obesity, especially central obesity and increased visceral fat due to physical inactivity, and consumption of a high-calorie/high-fat and high sugar diets are major contributing factors. Lack of proper nutrition, absence of portion control, and failure to exercise adds up to this debilitating and life threatening condition that is taken far too lightly by far too many.

Diabetes is a condition that can be handled with a disciplined lifestyle taking informed decisions. Apart from having medicines on time, one needs to maintain a good healthy lifestyle to be able to manage diabetes. Conventionally, in India, and globally too, diabetes management has always been about targeting the triad of FPG (fasting plasma glucose) i.e. fasting sugar levels , PPG (postprandial glucose), and HbA1c i.e. the average of glucose levels in last three months. However, recent studies suggest the quintessential need for a paradigm shift to incorporate glycemic variability and quality of life (QoL) in the holistic diabetes control regimen calling it ‘Glycemic Pentad’.

What is Glycemic Pentad & its importance:

Asian Indian diabetic patients are different from other ethnicities. Generally, carbohydrate content in the Indian diet is close to 65%, which is more than recommended for diabetic patients. Of the whole ingredients in an individual’s diet, carbohydrates have the greatest influence on blood glucose level, and both the amount and type of carbohydrate intake are important determinants of postprandial glucose. Since, Indians consume food with high glycemic index, overall glycemic control in Indian diabetic population demands a separate attention – a need for knowing Glycemic Pentad.

Glycemic Pentad acknowledges a multidimensional approach in treating diabetes. It suggests that the therapy should not only aim at the triads (FPG, PPG, HbA1c), but also consider Glycemic Variability and the socio-economic and psychological status (QoL) of the patients while treating diabetes.

Glycemic Variability can be simply defined as the degree of daily blood glucose fluctuations in an individual. Controlling the glycemic triad (FPG, PPG, and HbA1c) does not prevent the occurrence of diabetic complications and recent studies have shown that mortality rate increased even after maintaining good HbA1c. Subsequent studies established a relation between oscillating glucose levels and oxidative stress and corroborated the hypothesis that HbA1c together with glycemic variability (GV) might be a superior indicator of glucose control.

The other element added to Glycemic Pentad is quality of life (QoL) emerging as an important parameter in the general disease management routine. The QoL is defined as a multidimensional construct incorporating an individual’s subjective perception of physical, emotional, and social wellbeing. In fact, in today’s time with increase in stress levels, the sedentary lifestyle that we all lead, it is imperative that we manage a good quality of life thereby keeping diabetes at bay.

Thus, measurement of these five elements of Glycemic Pentad can help doctors have more productive discussions with their patients, make more informed treatment decisions and modify treatment accordingly to suit a patient’s individual lifestyle. These reports can also be used as an information tool by people with diabetes to see the impact of food, medication, health and exercise on their blood sugar levels, thus empowering patients to take control of their diabetes themselves.

With immense pride “India Live” celebrated its 10th national conference in Mumbai from 28th February to 3rd March 2019. The conference turned out to be a gold mine of information, with emphasis on academics, education and exchange of knowledge with leaders in interventional cardiology from both India and abroad.